HHS Posts Regulatory Agenda

The U.S. Department of Health and Human Services has posted a list of the regulations it is already working on or intends to work on in the coming months.

Included in the list are links to the individual subjects that lead to descriptions of the subject and HHS’s intentions as well as the latest information on the status of the anticipated regulation and its priority within the agency’s overall regulatory work.  Among the listed regulations are a number that address Medicare and Medicaid.

Go here to see the list.…

Medicaid APMs Moving in New Directions

For the most part, states’ use of alternative payment models in their Medicaid programs so far have focused on the work done by primary and acute-care providers.  Now, a number of states are starting to extend their use of APMs in other areas, including:

  • behavioral health providers
  • safety-net providers
  • long-term care providers

For a look at what states are doing to drive value in Medicaid payments in these new areas, see the Commonwealth Fund article “The Next Generation of Paying for Value in Medicaid,” which can be found here.…

Proposed “Public Charge” Regulation Could Hit Medicaid, Hospitals

If a regulation proposed by the Department of Homeland Security to redefine what constitutes a “public charge” is adopted, millions of people currently enrolled in the Medicaid and Children’s Health Insurance Program might choose to disenroll from those programs rather than risk losing their opportunity to obtain legal permanent resident status in the U.S.

The proposed regulation seeks to filter out of possible residency status individuals who might become public charges, or dependent on government programs, over time.

A new analysis published by the Kaiser Family Foundation concluded that

Under the proposed rule, individuals with lower incomes, a health condition, less education, and/or who are enrolled or likely to enroll in certain health, nutrition, and housing programs would face increased barriers to obtaining LPR [legal permanent residency] status.

The study notes that

Nearly all (94%) noncitizens who originally entered the U.S. without LPR status have at least one characteristic that DHS could potentially weigh negatively in a public charge determination.

To avoid losing eligibility for legal permanent residency status, the analysis suggests,

 The proposed rule would likely lead to disenrollment from Medicaid and other programs among noncitizens who intend to seek LPR status as well as among a broader

CMS to Watch the Watchdogs

The Centers for Medicare & Medicaid Services intends to pay closer attention to the work performed by accrediting organizations for different types of health care providers.

With all providers and suppliers participating in Medicare subject to some kind of accreditation and inspection process, CMS intends to monitor more closely the work of those accreditors and inspectors after a 2018 Wall Street Journal investigation discovered facilities with continuing problems that continued to serve patients and keep their accreditation.

With this in mind, CMS will redesign how accrediting organizations do their work, publicly post performance data on those accrediting organizations, and submit to Congress an annual report on its findings.

In a news release, CMS explained that

Today, the public relies on accreditation status as a way to gauge providers’ and suppliers’ quality of care. By posting more detail—accredited hospitals’ complaint surveys, out-of-compliance information, and performance data for AOs themselves—CMS will offer the public more nuanced information than accreditation status alone provides. 

To learn more about why CMS is making these changes and what form these changes will take, go here to see a CMS news release on the subject and here to see a Fierce Healthcare article.…

Physicians Push Back Against Medicare Telemedicine Proposal

A proposal to enable Medicare to make greater use of telemedicine as a means of serving patients is receiving surprising pushback from physicians.

The Centers for Medicare & Medicaid Services has proposed paying doctors $14 for what would amount to a five-minute telephone “check-in” call with patients.

Some physicians note that they already have such telephone conversations patients – and do not charge for those calls.  Others fear the new service will increase their patients’ health care costs because they would incur a co-pay for such conversations.  The chairman of the Medicare Payment Advisory Commission (MedPAC), himself a physician, has written that “Direct-to-consumer telehealth services…appear to expand access, but at a potentially significant cost and without evidence of improved quality.”

Learn more about CMS’s telemedicine proposal, what Medicare hopes to accomplish by expanding access to telehealth services, and why some providers do not share CMS’s enthusiasm for telemedicine in this Kaiser Health News article.

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